Bruxism in children with nasal obstruction

doi:10.1016/j.ijporl.2007.11.014

International Journal of Pediatric Otorhinolaryngology

Volume 72, Issue 3, March 2008, Pages 391-396

https://doi.org/10.1016/j.ijporl.2007.11.014 Get rights and content

Summary

Introduction

Bruxism is characterized by repeated tooth grinding or clenching. The condition can occur in all age ranges and in both genders, being related or not to other oral habits.

Objective

The objective of the present study was to investigate the occurrence of bruxism in children with nasal obstruction and to determine its association with other factors.

Methods

Sixty children with nasal obstruction seen at the Otorhinolaryngology Outpatient Clinic of the University Hospital of Ribeirão Preto participated in the study. The data were obtained using a pre-established questionnaire applied to the person responsible and by orofacial evaluation of the patient. The participants were divided into two groups: group with bruxism (GB) as reported by the relatives and with the presence of tooth wear detected by clinical evaluation, and group without bruxism (GWB), consisting of children with none of the two symptoms of bruxism mentioned above.

Results

The presence of bruxism exceeded its absence in the sample studied (65.22%). There was no significant difference (P < 0.05) between groups regarding gender, phase of dentition, presence of hearing diseases, degree of malocclusion, or child behavior.

Conclusion

Bruxism and deleterious oral habits such as biting behavior (objects, lips and nails) were significantly present, together with the absence of suction habits, in the children with nasal obstruction.

Introduction

Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding which may occur during the day or more commonly at night in an unconscious manner [1], [2]. Bruxism is classified as centric when tooth clenching occurs in centric occlusion or in maximum intercuspation without sliding, and as eccentric when there is tooth sliding in protrusive and lateroprotrusive positions, causing facet wear usually in anterior and posterior teeth [3]. The etiology of bruxism is considered to be multifactorial, including local [1], [4], psychological [1], [5], [6], [7], [8], and neurological factors [1].

Bruxism may be caused by allergic processes, by asthma and by respiratory airway infection. Thus, bruxism may be a reflex of the central nervous system due to an increase in negative pressure in the middle and/or inner ear caused by allergic edema of the mucosa of the auditory tubes. The disorder of the middle ear would induce a reflex action in the temporomandibular joint (TMJ), stimulating the nucleus of the trigeminus nerve [2]. Other investigators have mentioned the association between bruxism and respiratory problems [5], [9], [10], [11], [12], [13], [14]. Parafunctional habits have also been detected in children with bruxism, among them suction of a pacifier, nail biting and the habit of biting objects [2], [10].

The incidence of bruxism reported in the literature ranges from 5 to 81% of different age ranges, a fact attributed to different methods of investigation [1], [6], [8], [15], [16], [17], [18]. A previous study pointed out that subjective symptoms and clinical signs of TMJ disorders, including bruxism, were more common among boys than girls in the 6–8 year age range [19].

An early diagnosis should be made to avoid damage such as dental mobility, headache and traumas. Some authors believe that childhood bruxism does not always need to be treated since the child is in the growing process and is resistant to bruxism [1]. However, if damage to the stomatognathic system is present, occlusal adjustment and orthodontic braces [15], an interdental splint [20], psychotherapy [15], [20], [21], [22], and exercise [15] are prescribed. Additional therapeutic modalities have been suggested, but there is no consensus about the most efficient one [23].

The objective of the present study was to investigate the occurrence of bruxism in children with nasal obstruction and to determine its association with other factors.

Section snippets

Methods

The study was approved by the Research Ethics Committee of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (no. 1959/02) and the persons responsible for the children signed a term of informed consent for their participation in the study.

The study was initially conducted on 60 children of both genders aged 2–13 years with an otorhinolaryngologic diagnosis of nasal obstruction. The children were followed at the Otorhinolaryngology Outpatient Clinic of the

Results

Analysis by the binomial test revealed that the presence of bruxism was significantly higher than its absence (P < 0.05) in the study sample, i.e., more children met the criteria of GB (30 subjects) than of GWB (16 subjects).

GB consisted of 21 boys (70%) and 9 girls (30%) aged 2 years and 1 month to 10 years and 9 months. GWB consisted of 8 boys (50%) and 8 girls (50%) aged 2 years and 9 months to 12 years and 8 months.

Comparison of GB and GWB indicated a lack of significant differences (P > 0.05)

Discussion

The diagnosis of bruxism may be incomplete if only the presence of tooth wear is considered. Tooth wear may indicate a history of previous, and not current, bruxism, or the habit may be recent with a duration insufficient to cause tooth wear [9]. Thus, the methodology employed in the present study was based on two criteria for the definition of the occurrence of bruxism, i.e., clinical observation of tooth wear and a report of tooth clenching and grinding by the persons responsible for the

Conclusion

In the sample studied here, consisting of children with airway diseases, there was a prevalence of bruxism, a significant presence of deleterious oral habits such as biting (objects, lips and mails) and the absence of suction habits.

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Cited by (30)

Determinants of probable sleep bruxism in a pediatric mixed dentition population: a multivariate analysis of mouth vs. nasal breathing, tongue mobility, and tonsil size
2021, Sleep Medicine
Citation Excerpt :
This study shows impaired nasal breathing statistically significantly associated with increased odds of PSB (Table 2, Fig. 3). In a previous study of children diagnosed with nasal obstruction from 2 to 13 years of age, 65.2% of those individuals presented with bruxism [24]. Intragroup analysis revealed a prevalence of allergic rhinitis associated with other airway diseases in the group with bruxism, confirming the fact that allergic children are more predisposed to bruxism than non-allergic children [25].
This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of ‘probable’ sleep bruxism in children.
From March 2018 until March 2019, a cross-sectional clinical study was performed with ninety-six healthy children ages 6–12 years who presented for routine dental examination at the UCLA pediatric dental clinic. Variables of interest included: (1) assessment of probable bruxism based on parental awareness on the frequency of tooth grinding during sleep and clinical signs of bruxism based on tooth wear; (2) parental reports of mouth breathing while awake and asleep, snoring during sleep, difficulty breathing and/or gasping for air during sleep; (3) parental reports of psychosocial distress; (4) assessment of tonsil hypertrophy, tongue mobility, and nasal obstruction. Three pediatric dental residents were calibrated to perform the clinical data collection. All dental residents were graduated dentists with licensure and at least one year of experience examining children. The methodology to take the specific measurements administered in the manuscript were calibrated between the data-collectors under the supervision of a board-certified pediatric dentist and orthodontist (AY).
The mean age of individuals was 8.9 (SD = 1.9) years with a gender distribution of 46 males and 50 females. There were 23 out of the 96 (24%) individuals who met the diagnostic criteria for probable sleep bruxism (PSB). Sleep Disturbance Scale for Children (SDSC) scores were significantly elevated among children positive for PSB, indicating that they are at higher risk for sleep disturbances (PSB-positive: 45.1 ± 13.0, PSB-negative: 34.8 ± 5.5; p < 0.0001). Impaired nasal breathing, parental reports of mouth breathing when awake or asleep, restricted tongue mobility, and tonsillar hypertrophy were found to be significant risk factors for PSB. Exploratory analysis further suggests a synergistic effect between tonsil hypertrophy, restricted tongue mobility, and nasal obstruction. The incidence of probable sleep bruxism among individuals without any of the exam findings of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction was 5/58 (8.6%), whereas the incidence of PSB among individuals with all three exam findings was 10/11 (90.9%), p < 0.0001. Among the 23 individuals with PSB, however, there were n = 5 (21.7%) who did not have any of the three exam findings, suggesting an additional role of psychosocial distress, postural maladaptation, malocclusion, or other factors in the etiology of sleep bruxism.
This study shows that tonsil hypertrophy, restricted tongue mobility, and nasal obstruction may have a synergistic association on the presentation of PSB. Dentists should evaluate for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction in the evaluation of PSB, as these exam findings are highly prevalent in the majority of cases.
Sleep bruxism in children and adolescents
2015, Revista Chilena de Pediatria
El bruxismo es una actividad muscular mandibular repetitiva, caracterizada por apriete y rechinamiento dentario. Se considera un fenómeno regulado por el sistema nervioso central, principalmente, e influido por factores periféricos. Tiene 2 manifestaciones circadianas distintas: puede ocurrir durante el sueño –indicado como bruxismo de sueño– o durante la vigilia –indicado como bruxismo despierto–. El bruxismo es mucho más que solo el desgaste que podemos observar en los dientes: de hecho, se asocia con dolor orofacial, cefaleas, trastornos del sueño, trastornos respiratorios durante el sueño como el síndrome de apnea e hipoapnea del sueño, trastornos del comportamiento o asociados al uso de fármacos. Además, se ve influido por factores psicosociales y posturales, lo que indica que parafunciones oromandibulares, los trastornos temporomandibulares, la maloclusión, los altos niveles de ansiedad y de estrés, entre otros, podrían influir en la ocurrencia de bruxismo. Su etiología es considerada hoy como multifactorial. Su detección temprana, diagnóstico, tratamiento y la prevención de sus posibles consecuencias en los pacientes es responsabilidad del pediatra y del odontólogo. El objetivo de esta revisión es actualizar los conceptos sobre esta patología y alertar a los profesionales de la salud sobre su detección precoz y su manejo oportuno.
Bruxism is a rhythmic masticatory muscle activity, characterized by teeth grinding and clenching. This is a phenomenon mainly regulated by the central nervous system and peripherally influenced. It has two circadian manifestations, during sleep (sleep bruxism) and awake states (awake bruxism). Bruxism is much more than just tooth wearing. It is currently linked to orofacial pain; headaches; sleep disorders; sleep breathing disorders, such as apnea and hypopnea sleep syndrome; behavior disorders, or those associated with the use of medications. It is also influenced by psycho-social and behavior factors, which means that oromandibular parafunctional activities, temporomandibular disorders, malocclusion, high levels of anxiety and stress, among others, may precipitate the occurrence of bruxism. Nowadays, its etiology is multifactorial. The dentist and the pediatrician are responsible for its early detection, diagnosis, management, and prevention of its possible consequences on the patients. The aim of this review is to update the concepts of this disease and to make health professionals aware of its early detection and its timely management.
Sleep Bruxism: A Comprehensive Overview for the Dental Clinician Interested in Sleep Medicine
2012, Dental Clinics of North America
Citation Excerpt :
For example, it has been shown that children with headaches frequently have concomitant sleep problems, such as SB and SDB, and a higher incidence of TMD.144,145 Although SB and SDB (eg, upper airway resistance, obstructive sleep apnea [OSA], and central sleep apnea) have frequently been associated, the possible cause-and-effect relationship has not yet been elucidated.29,146–148 Two open clinical studies and one case report have provided indirect evidence for this relationship by showing a decrease in SB after different SDB treatments (eg, adenotonsillectomy and continuous positive airway pressure).149–151
Nasal obstruction may alleviate bruxism related temporomandibular joint disorders
2011, Medical Hypotheses
Citation Excerpt :
The majority of studies report that there is a relationship between bruxism and TMD [3]. Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding which may occur during the day or more commonly at night in an unconscious manner (sleep bruxism-SB) [4]. The uploading caused by bruxism over the TMJ leads to TMD.
Temporomandibular disorder (TMD) is a collective term used to identify a group of musculoskeletal conditions of the temporomandibular region. Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding in an unconscious manner. Over the time bruxism may lead to TMD by the uploading it causes. Nasal obstruction is a common complaint that necessitates mouth breathing when severe. The treatment of bruxism is frequently performed by oral appliances, which induce occlusal disengagement and relax jaw musculature and therefore reduce the force on the temporomandibular joint (TMJ). We believe that nasal obstruction may indirectly have a preemptive and therapeutic effect on sleep bruxism related TMD by causing mouth breathing.
Sleep Bruxism: A Sleep-Related Movement Disorder
2010, Sleep Medicine Clinics
Citation Excerpt :
The concomitant occurrence of sleep bruxism and sleep apnea or snoring has been reported in pediatric patients.13,22,202 It has also been suggested that upper airway and face morphology contribute to the SB seen in pediatric patients.203–206 Because upper airway morphology is a significant risk for snoring and sleep apnea in children, the occurrence of SB in children with abnormal upper airway morphology provides a future challenge to be considered in the pathophysiology and management strategies in pediatric SB patients.189
Growth and mouth breathers
2019, Jornal de Pediatria
Citation Excerpt :
At cephalometric evaluation, an increased Y-axis is observed (Fig. 2). The presence of snoring, whether associated with apnea or respiratory distress during sleep, is a frequent complaint among parents or caregivers, followed by restless sleep, frequent night awakenings,1 bruxism,10 and sometimes somnambulism.10–12 Mouth breathing is often associated with other harmful oral habits, such as thumb sucking, pacifier sucking, sucking and biting the lips, and nail biting, among others, impacting quality of life.13
To assess the relationship between mouth breathing and growth disorders among children and teenagers.
Search on MEDLINE database, over the last 10 years, by using the following terms: “mouth breathing”, “adenotonsilar hypertrophy”, “allergic rhinitis”, “sleep disturbance” AND “growth impairment”, “growth hormone”, “failure to thrive”, “short stature”, or “failure to thrive”.
A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical).
Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.
Avaliar a relação entre respiração oral e distúrbios do crescimento entre crianças e adolescentes.
Busca na base de dados do MEDLINE, nos últimos 10 anos, com o emprego dos seguintes termos: “mouth breathing” ou “adenotonsilar hypertrophy”, ou “allergic rhinitis” ou sleep disturbance” AND “growth impairment” ou “growth hormone” ou "failure to thrive” ou “short stature” ou ‘failure to thrive”.
Foram identificados 247 artigos, que após a leitura dos títulos foram reduzidos a 45, cujos resumos foram lidos e desses 20 foram considerados de importância e integraram a revisão. Além desses, referências por eles citadas e livros-texto específicos sobre respiração oral considerados importantes foram incluídos. A hipertrofia de tonsilas palatinas e/ou faríngeas, associada ou não à rinite alérgica, assim como a rinite alérgica mal controlada, é a principal causa de respiração oral na criança. Distúrbios respiratórios do sono são frequentes entre esses pacientes. Vários estudos associam a respiração oral à redução do crescimento, bem como à redução de liberação de hormônio do crescimento, que são restabelecidos após o tratamento efetivo da respiração oral (clínico e/ou cirúrgico).
A respiração oral deve ser cogitada como possível causa de retardo de crescimento em crianças e cabe ao pediatra a tarefa de investigar esses pacientes de forma mais abrangente.

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Bruxism in children with nasal obstruction

Summary

Introduction

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Am. J. Orthod.

Chest

Arch. Oral Biol.

Sleep Med.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Arch. Oral Biol.

J. Am. Dent. Assoc.